Excess Breast Tissue Probably Not Dangerous

People - House Calls - ASK LAKE DOCTORS

October 21, 1998|By Richard T. Bosshardt Special to the Sentinel

Question: About a year ago I noticed that my underarms were swollen. When my doctor checked it, he said that it was only some breast tissue that had moved or developed under the armpit. He told me the only way to get rid of it is to do surgery.

Can you tell me more about this? Could it turn into something serious? Will insurance pay to have it removed?

Also, one of my nipples does not stick out like the other. All I have is a dimple there.

Can this be fixed?

Answer: Your doctor may well be correct, but the only way to verify his diagnosis would be to do a biopsy of this tissue to confirm that it is, indeed, breast tissue. Accessory breast tissue is not an uncommon problem and can be found in men or women.

The breast is what is known as a modified sweat gland. It develops from a line of germinal cells situated in what is known as the ``milk line,'' which runs from the armpit down to the groin.

As the embryo develops, the cells in this ridge disappear, except on the anterior chest, where they migrate into the deeper tissues to form the breast. Sometimes small nests of these cells persist and can form accessory breast tissue anywhere along this line.

One of the most common birth defects is an accessory nipple, which may be found anywhere along the milk line.

Many people live their lives thinking they have a small brown mole on their chest, abdomen, or groin when, in fact, if they looked closely they would realize that this is not a mole, but rather a nipple.

Breast tissue may or may not accompany the accessory nipple.

Sometimes, accessory breast tissue may first be noticed during pregnancy. As the body prepares to produce milk, all of the breast tissue begins to increase in size.

Normal breasts become larger and engorged, and small islands of breast tissue elsewhere enlarge also and may become apparent for the first time. Accessory breasts can produce milk, too.

Your situation may also be the result of an enlarged breast ``tail.''

The natural shape of the breast is like a pear, the lower portion being rounder and fuller and tapering toward the upper pole of the breast. This produces the natural breast shape seen in most young women.

If you can imagine that the pear is tilted a bit so that the tapering portion is pointing toward the armpit, you have a good general idea of how the tissue is positioned on the chest wall.

This tapering portion is called the ``tail'' of the breast and may be of varying sizes in proportion to the remainder of the breast. Enlargement of the tail could produce the swelling that you noticed.

Whether the fullness is caused by an enlarged tail of the breast or accessory breast tissue, the risk of breast cancer, cysts, infection or other problems is no greater than for normal breast tissue.

Fullness in the armpit area is probably no cause for alarm, but if this is a new development, then it should be checked by a doctor and followed closely. If the enlargement is caused by some hormonal changes in the body, such as produced by pregnancy or taking birth control pills, the condition may correct itself once the hormone levels return to normal.

Enlarged breast tissue, and any accessory nipples with or without breast tissue, can be removed surgically and this is how it is usually treated.

The surgery may range from minor outpatient surgery to something more like a mastectomy, depending on the location and extent of the breast tissue. The tissue removed should always be checked by a pathologist to be sure that a cancer or some other treatable cause of the enlargement is not missed.

Other things that can cause a mass in the armpit are enlarged lymph nodes, which may reflect an infection or other inflammatory condition somewhere in the body, especially the arm on that same side.

Fatty tumors also can occur in the armpit. They are almost always benign and can be very difficult to distinguish clinically from breast tissue. If the condition is not causing a disfiguring appearance and has no symptoms, surgery probably isn't needed.

Insurance companies will often cover the removal or at least the biopsy of an enlarged or accessory breast because the condition is not normal, it is important to know whether the tissue is diseased and the enlarged or accessory breast is sometimes disfiguring.

Policies vary widely, and the best thing you can do is to check with your company to see what their policies are regarding such such surgeries.

The condition of inverted nipples is very common. It is usually caused by a shortening of the breast ducts which tether the nipple, preventing it from protruding normally.

The condition can be easily corrected by surgery to cut the ducts, free up the nipple, then secure it in the new position permanently with suturing.

The ability to breast-feed may be impaired as a result, but breast-feeding is usually difficult with inverted nipples anyway.

Sensation will usually be preserved. New onset of nipple retraction in a previously normal nipple needs to be checked right away be a doctor - it an be a sign of cancer of the breast.